Journal of Ophthalmic & Vision Research最新文献

Purpose: To report five cases of structural weakness at the haptic-optic junction of the CT Lucia 602 intraocular lens (IOL) (Carl Zeiss Meditec Inc., Dublin, CA), including two optic breakages and three optic microfractures, while using the Yamane flanged intrascleral haptic fixation surgery (FIHFS).

Methods: A retrospective chart review of five cases that underwent Yamane FIHFS by the same surgeon between 2020 and 2022 was performed. Patients' demographics, operative technique, postoperative outcomes, and adverse events were recorded over a 12-month follow-up period.

Results: One case of optic breakage, noted on postoperative week 1 (POW1), had the optic with the trailing haptic suspended in the vitreous while both haptic flanges remained secured to the sclera, requiring IOL exchange. The second case of optic breakage was noted intraoperatively and required explantation of the IOL with subsequent placement of an iris-fixated IOL. Three cases of optic microfractures were observed with no long-term complications. All five fractures occurred at the junction of the leading haptic.

Conclusion: Optic breakage and microfractures at the haptic-optic junction are unusual complications of intrascleral fixated IOL using the Yamane technique. To the best of our knowledge, this has not been previously reported with the CT Lucia 602 IOL. The authors recommend careful selection of the IOL material for this technique to prevent possible complications.

Purpose: To assess the effect of empagliflozin on the expression of SGLT-2 and GLUT-1 in the chorioretina of streptozotocin-induced diabetic rats.

Methods: An in vivo experimental study was performed on Wistar rats. After a 2-week adaptation period, the rats were allocated to one of four groups. The group allocations were as follows: (K1) negative control (no intervention); (K2) positive control injected with streptozotocin (STZ) without treatment; (K3) positive control injected with STZ and treated with metformin; and (K4) positive control injected with STZ and treated with empagliflozin. SGLT-2 and GLUT-1 expressions were examined using the Western blot technique.

Results: SGLT-2 was expressed in the chorioretinal tissue of all groups; administration of SGLT-2 inhibitors could suppress its expression. The average band thickness indicated that SGLT-2 expression was higher in diabetic rats compared to rats with normal sugar levels. GLUT-1 expression was noticed in all groups based on the chorioretinal examination. It did not change in the metformin group, whereas the empagliflozin group showed a significant decrease in the GLUT-1 expression.

Conclusion: Both metformin and empagliflozin suppress the expression of SGLT-2 and GLUT-1 in the chorioretina of diabetic rats. In comparison, empagliflozin seems to be more potent in reducing this expression.

Purpose: To report a case of eosinophilic granulomatosis with polyangiitis (EGPA) initially presenting as orbital involvement, describe its successful management, and provide a comprehensive literature review.

Case report: A 33-year-old female patient presented with swelling, redness, tenderness, and a mass under the left upper eyelid for one month. Upper lid eversion showed a multilobulated lesion in the subconjunctival area of the same region. The patient's medical history included asthma and atrial septal defect surgery. Orbital MRI revealed a soft tissue mass infiltrating the superior and lateral aspects of the conal and extraconal regions in the anterior orbit, with extension toward the preseptal area. The lesion underwent incisional biopsy, and histopathological findings were consistent with the diagnosis of EGPA. The patient's blood tests revealed eosinophilia and a negative antineutrophil cytoplasmic antibody. After excluding other similar pathologies such as granulomatosis with polyangiitis, we observed a dramatic regression in her orbital lesion following systemic steroid therapy.

Conclusion: The diagnosis of EGPA, a rare clinical presentation, is crucial for ophthalmologists because it provides early recognition of the systemic disease and can help slow its progression by initiating appropriate treatment in a timely manner.

Purpose: To evaluate and compare the clinical features and efficacy of botulinum toxin A (BTX-A) injection versus surgery in acute-onset concomitant esotropia (ACE) in children.

Methods: This retrospective comparative clinical study was conducted on 40 children with ACE. The patients were assigned to either the surgery group (n = 23) or the BTX-A group (n = 17). Successful motor outcomes were defined as residual esodeviation of $<$ 5 prism diopters (PD), while successful sensory outcomes were defined as the presence of any evidence of sensory fusion or stereopsis.

Results: The average treatment age in this study was 7.02 $\pm$ 3.72 years in the BTX-A group and 6.41 $\pm$ 2.83 years in the surgery group. There were 5 cases of type I (12.50%), 26 cases of type II (65.00%), and 9 cases of type III (22.50%) for ACE. The deviation before treatment was +(41.35 $\pm$ 16.90) PD at near and +(39.71 $\pm$ 14.94) PD at distance in the BTX-A group. In the surgery group, the results were +(49.22 $\pm$ 18.25) PD at near and +(47.00 $\pm$ 18.53) PD at distance. After treatment, based on the measured deviation, total motor success was 95.00% (38/40) at near and 90.00% (36/40) at distance. Following treatment, 94.59% (35/37) of patients with ACE exhibited fusion, 86.84% (33/38) had near stereopsis, and 72.97% (27/37) had distance stereopsis. The motor and sensory success rates were not significantly different between the BTX-A and surgery groups. There were no statistically significant differences in motor outcomes or sensory outcomes among the three subtypes of ACE (all P $>$ 0.05).

Conclusion: In our study, type II was the most common clinical classification for ACE. Favorable outcomes could be achieved with both BTX-A injection and surgery. There was no difference in motor or sensory outcomes regardless of clinical classification. BTX-A injection is minimally invasive, allows early intervention, and may be the preferred approach for managing ACE in children.

This systematic review investigated the role of artificial intelligence (AI) in the knowledge, attitude, and performance of ophthalmology residents. We conducted a comprehensive systematic search in international databases including PubMed, Web of Science, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Education Resources Information Center (ERIC) using keywords "artificial intelligence", "deep learning", "ophthalmology", "ocular surgery", and "education" and their synonyms. The keywords were extracted from medical research studies published from January 1, 2018 to April 15, 2024. The quality of these studies was evaluated by using the STORBE, JADA, and JBI appraisal tools. Six studies were selected based on the defined criteria. Specifically, five of these studies investigated the effectiveness of AI interventions on the performance of ophthalmology residents in diagnosing myopia, corneal diseases (using a confocal microscope), staging of diabetic retinopathy, abnormal findings in posterior segment ultrasonography, including retinal detachment, posterior vitreous detachment, and vitreous hemorrhage, and 13 fundus diseases. One study investigated the residents' attitudes about the application of an AI model for providing feedback in cataract surgery. All six studies showed positive results. Due to the small number of studies found through our systematic search and the variations in the investigated outcomes and study settings, it was not possible to conduct a meta-analysis. Despite the positive reports on improving the diagnostic performance of residents and their attitude toward the usability of AI models in cataract surgery, it is recommended that more studies be conducted in this area. These studies should replicate previous investigations using similar study settings while maintaining high quality standards and addressing existing limitations.

Purpose: We present a case of hemolacria, which emerged as an unusual mass in the lacrimal sac.

Case report: A nine-year-old girl presented with intermittent unilateral hemolacria and episodes of dacryocystitis with no further remarkable medical or surgical history. CT scan indicated the presence of well-defined calcified tissue enclosed within the lacrimal sac. Following external dacryocystorhinostomy, well-formed firm tissue resembling bony tissue was extracted and sent for pathological evaluation, along with biopsies from the lacrimal sac. Histopathological analysis revealed heterotopic bone formation with nonspecific inflammation of the lacrimal sac. No underlying cause was discernible in the complementary assessment, and no recurrence was noted at one-year follow-up.

Conclusion: A child with hemolacria was found to have heterotopic ossification in the lacrimal sac with no discernible underlying cause.

Purpose: To evaluate the impact of inadvertent intraoperative microperforation of the trabeculo-Descemet's membrane (TDM) on postoperative outcomes in cases with cataract and either primary open-angle glaucoma (POAG) or pseudoexfoliative glaucoma (PEXG) during combined phacoemulsification and deep sclerectomy (PDS).

Methods: In this prospective case-control study, 73 eyes of 73 patients with cataract and POAG/PEXG who underwent PDS were enrolled. Patients were divided into two groups based on the presence or absence of inadvertent intraoperative TDM microperforation. The primary outcome measures included intraocular pressure (IOP), number of antiglaucoma drugs, and assessment of adverse effects during a six-month follow-up period.

Results: Significant decreases in IOP were observed at all follow-up time points (day 7, month 1, and month 6) in both groups compared to baseline (P $<$ 0.001). No significant differences in IOP were found between the groups at any time point, except on day 7, while the perforation group exhibited a significantly lower IOP compared to the non-perforation group (11.84 $\pm$ 4.78 vs 14.03 $\pm$ 2.50 mmHg, P = 0.017). At month 6, the mean number of antiglaucoma drugs was 0.19 $\pm$ 0.46 in the perforation group and 0.06 $\pm$ 0.23 in the non-perforation group, suggesting a significant reduction in both groups compared to baseline (P $<$ 0.001) with no statistically significant difference between the two groups (P = 0.124). Hypotony was observed in 3 (8.1%) eyes with perforation, but it resolved without persistent complications in subsequent follow-ups.

Conclusion: Inadvertent TDM microperforation during PDS for POAG or PEXG did not impact IOP outcomes compared to non-perforated cases over a six-month period, nor did it increase the incidence of complications.

Purpose: To report a case of a patient diagnosed with arteritic anterior ischemic optic neuropathy, who was later diagnosed with a severe form of Takayasu arteritis (TA).

Case report: A 34-year-old lady presented with a sudden, painful loss of vision in the left eye for four months associated with headache and jaw claudication. Ocular examination revealed features suggestive of arteritic anterior ischemic optic neuropathy and microaneurysms scattered throughout the fundus in both eyes, consistent with Takayasu retinopathy. General examination and investigations, including CT aortogram, confirmed the diagnosis of TA. Despite being put on maximal immunosuppression, she developed severe systemic manifestations within the next three months and passed away due to the illness.

Conclusion: AION as a presenting feature in the setting of TA is uncommon, and its occurrence may indicate a progressive course and poor systemic outcomes.

Purpose: To investigate the incidence and risk factors of intraoperative complications during phacoemulsification surgery performed by ophthalmology residents at an academic training center.

Methods: This comparative case series included 1121 eyes of 821 patients that underwent phacoemulsification cataract surgery by ophthalmology residents from March 2020 to March 2021. Patients' medical records were reviewed for demographics, systemic and ophthalmic comorbidities, biometric data, surgical details, anesthesia type, residents' training year, and the occurrence of any intraoperative complications. Multivariate models were used to identify potential risk factors for intraoperative complications.

Results: Intraoperative complications were observed in 63 eyes (5.6%). From the most to the least frequent, they included posterior capsular rupture with vitreous loss in 29 eyes (2.6%), anterior capsular tear in 21 eyes (1.9%), nucleus drop in 8 eyes (0.7%), zonular dehiscence in 3 eyes (0.3%), and posterior capsular rupture without vitreous loss in 2 eyes (0.2%). On univariate analysis, mature or brunescent cataracts (OR = 3.096, P = 0.031), residents' training year (OR = 2.238, P = 0.017), and pseudoexfoliation (OR = 2.247, P = 0.049) were associated with vitreous loss. Multivariate data analysis indicated that mature or brunescent cataracts (OR = 4.046, P = 0.009) and residents' training year (OR = 3.238, P = 0.005) were independent risk factors for vitreous loss.

Conclusion: We observed a higher rate of intraoperative complications in eyes with mature or brunescent cataracts or in procedures performed by less experienced residents. Proper case selection and direct attending supervision are crucial in preventing intraoperative complications at ophthalmology training centers.

Purpose: Human vision is subnormal in an aquatic environment, and studies have used different methods to measure visual functions with water-induced blur (WIB). In this study, we compared vernier acuity measured using three different WIB simulation methods.

Methods: Sixty young adults (20 in each group) with best-corrected visual acuity of $\ge$ 6/6 participated in the study. Three different methods, one for each study group, were used to simulate WIB in order to measure the vernier acuity. The methods comprised M1: a glass tank filled with water containing a wave motor to produce waves, M2: a sprinkler with uncontrolled water splash against the glass, and M3: a sprinkler with controlled water splash against the glass. For each of the three methods, vernier acuity was measured binocularly (three trials of 50 presentations each) both at baseline (without simulated WIB) in the absence of WIB and under simulated WIB. This was conducted using FrACT presented on the Display++ monitor at a distance of 2 meters from the participant. The vernier target consisted of two vertical lines (1 x 15 arcmin) with a vertical separation of 0.5 arcmin.

Results: The mean baseline vernier acuity (arcsec) was found to be similar (F^{[2, 57]} = 0.20, P = 0.82) among all three groups (M1: 13.28 $\pm$ 5.84, M2: 14.44 $\pm$ 6.34, M3: 14.05 $\pm$ 3.28). Vernier acuity with simulated WIB was least degraded with M1 (19.84 $\pm$ 8.40) and more degraded with M2 (288.74 $\pm$ 56.61), followed by M3 (49.14 $\pm$ 20.13). One-way ANOVA revealed a significant difference among the three methods (F [2, 57] = 354.72, P $<$ 0.001).

Conclusion: Our results suggest that the impact of simulated WIB on vernier acuity is not comparable due to differences in the strength of blur and the varied spatial and temporal properties of different simulated WIB methods. This emphasizes the need to develop a blur metric specific to WIB to objectively quantify its effect on different visual functions.